As compared to Continuous Labor Epidural Analgesia, Dural Puncture Epidural Analgesia only reduces the incidence of immediate failures of epidural analgesia
Abstract Number: GM-5
Abstract Type: Original Research
Introduction: Dural puncture epidural (DPE) technique with 25G Pencan needle through 17G Tuohy needle without administering intrathecal analgesics allows additional confirmation of epidural space (cerebrospinal fluid flow from Pencan confirms that Tuohy is in epidural space), testing for early epidural catheter failure (Combined Spinal Epidurals prevent testing of epidural catheters due to masking effects of intrathecal analgesics), and enhancement of labor analgesia by intrathecal transfer of epidural analgesics across the dural puncture. Hypothesis: DPE technique would provide superior labor analgesia as compared to continuous labor epidural (CLE) technique without increasing incidence of adverse effects. Visual evidence of intrathecal transfer of epidural analgesics would be appreciable on ultrasound. Methods: The study was a prospective randomized study. After written informed consent, Group A patients received CLE and Group B patients received DPE. A screening lumbar ultrasound examination was done to assess depth of epidural space in transverse plane; and at the end of epidural placement, attempt was made to appreciate if any medication flow could be visualized across the posterior ligament complex in both groups. Results: 131 patients consented for study: 2 patients were excluded as they delivered within 30 minutes after consenting for study; 2 preterm patients were excluded as they were discharged home after failed progression of initial cervical dilatation; and 15 patients in Group B were excluded as dural punctures were not successful. Henceforth, on comparing data of Group A (n=63) with Group B (n= 49) (see Table 1), DPE technique had lower incidence of immediate failures of labor analgesia (P=0.0436) and less time was required to perform DPE (P=0.0321) as difficult unsuccessful dural punctures got excluded (n=15). Among the adverse effects, there was higher incidence of paresthesias while doing dural punctures (P<0.0001). Due to novelty of ultrasound assessment for medication flow, only two visualizations of epidural medications’ flow were appreciated among the first 20 cases wherein it was attempted. Finally, epidural depth assessment (n=112) with ultrasound correlated with loss of resistance technique (r=0.88; P<0.0001). Conclusion: As compared to CLE technique, DPE technique did not enhance labor analgesia except for fewer immediate failures in labor analgesia. Lumbar ultrasound imaging did not appreciate intrathecal transfer of analgesics.